“It used to be chaotic,” he recalled. “People were falling sick, particularly in the rainy season. Myself, my wife and children all had malaria, but in the last years it’s been improving. We’re now in a much better condition.”

Indonesia is demonstrating solid economic growth, with a growing, affluent middle-class, but by many measures Nusa Tenggara Timur Province has defied these trends. Diarrhoeal disease affects more than one in ten children annually in the province, which also has the worst sanitation coverage in the country and the fourth highest under-5 mortality rate.

But in Loli and other small communities here, local people are taking steps to improve the health of their families – and save the lives of their children.

Life-saving hygiene practices

Pneumonia and diarrhoea account for 2 million deaths among children under age 5 each year, a new UNICEF report reveals. But these diseases are preventable and, when they strike, treatable. Cost-effective vaccines and medications as well as improved hygiene practices could save millions of lives.

Mr. Hauloni, a community volunteer, is helping to promote some of these easy and life-saving interventions. He supports a community-based approach to total sanitation – known in Indonesia as STBM. STBM ensures that five important pillars are addressed: stopping open defecation; washing hands at critical moments, such as before food preparation; treating drinking water; and managing household solid waste and waste water properly.

A child in Nusa Tenggara Timur Province, Indonesia. The province has the fourth highest under-5 mortality rate in the country.

“Ever since I was child, malaria and diarrhoea were high,” Mr. Hauloni said. “People didn’t take care of the general environmental cleanliness, managing garbage and other waste. This made people prone to diseases.”

In Loli, where nearly three quarters of residents are considered poor, the financial burden of disease was often unbearable. Transportation to hospitals, treatment and medications could easily cost 500,000 rupiahs (US$50), Mr. Hauloni said – a price few could afford.

But the community-based approach to sanitation is helping to tackle this poverty. In Neke Village, local people are building latrines through a programme supported by the local government and UNICEF. The latrines are sold to nearby villages, raising funds for the community.

A new generation of health ambassadors

Even the youngest inhabitants are involved in turning back disease. At Gereja Masehi Injili Timor Primary School, Principal Lory Aploegi has led the drive to educate her students about good hygiene.

“When I first joined the school, I instructed them to install plastic bottles with holes so that children could wash their hands in running water,” she explained. “We teach children to wash their hands before they have their meal, to brush their teeth, to have clean, short nails and proper clothes and socks.”

Eleven-year old Anugrah knows the essentials. “It’s important to wash your hands so that bacteria won’t stick because this could make us sick,” she said.

Villagers in Neke Village, Nusa Tenggara Timur Province, Indonesia. People in the village build latrines to sell to nearby communities.

“One day I taught my brother, Aldo, how to wash his hands properly. I told him his way was wrong, it should be the right way,” Anugrah said.

A multi-pronged approach

These efforts are essential to addressing the underlying causes of deadly disease.

“We have to see this from many dimensions,” said Dr. Robin Nandy, UNICEF’s chief of child survival and development programmes in Indonesia. “Although improving sanitation and getting kids to wash their hands are critical, by themselves they are not enough. Conditions such as diarrhoea and pneumonia don’t exist in a vacuum – they are linked to poor nutrition, which means we have to address low rates of exclusive breastfeeding and poor knowledge of appropriate feeding amongst mothers.

“Children are more susceptible to diseases if affected by another [illness] – so that means we have to target children who don’t complete a full series of vaccinations. We have to improve the response to diseases when they do occur, through increased knowledge of diseases and their risks among mothers and communities so they seek treatment in a timely manner. And [we must] … invest in the skills and capacities of health workers.”

With nearly a quarter of all deaths among children under age 5 in Indonesia attributed to diarrhoeal disease, all these elements need to come together to save lives.